A psychometric examination of the cognitive flexibility scale and its association with Orthorexia Nervosa

Background: The Cognitive Flexibility Scale (CFS) is a 12-item self-report questionnaire designed to assess cognitive flexibility. Despite its widespread use, its psychometric properties have yet to be evaluated in the Italian context. Furthermore, while cognitive flexibility has emerged as a central correlate in Feeding and Eating Disorders, only a limited number of studies have investigated its association with Orthorexia Nervosa (ON), a clinical condition characterized by a pathological fixation with healthy eating. The present study aimed to fill these two knowledge gaps. Methods: A total of 803 participants (Mage = 33.89, SD = 9.44; 68.6% females) were enrolled in the investigation. The sample was randomly split into two subsamples: the first one for examining the psychometric properties of the CFS, and the second one for evaluating its association with ON symptoms. Participants completed self-report questionnaires assessing the constructs under investigation. Results: Confirmatory factor analysis revealed a global dimension of cognitive flexibility, alongside a method factor accounting for covariance arising by reverse-worded items. The CFS, which was factorially invariant across genders, yielded a reliable total score (ω = 0.834) and provided evidence of convergent and criterion-related validity. Importantly, structural equation modelling showed that cognitive flexibility was negatively associated with emotional distress resulting from violations of orthorexic dietary rules (β = -0.279, p <.001). Conclusions: The CFS demonstrated to be a psychometrically robust instrument in the Italian context. Moreover, cognitive flexibility may be an important treatment target for mitigating the distress derived from ON symptoms, informing the development of future therapeutic approaches.